Comparison of Immediate versus Delayed Lymphatic Reconstruction: Which Option Works Better to Prevent Post-Mastectomy Lymphedema?

BACKGROUND: An immediate lymphatic reconstruction (ILR) combining axillary reverse lymphatic mapping and lymphovenous anastomosis (LVA) has been gradually in the spotlight as a novel surgical technique to prevent lymphedema.[1] However, there is a counterargument that connecting small lymphatic vessels to large veins in the axillary region is not physiollogically reasonable given the pressure gradient.[2] Since it is difficult to decide whether to perform ALND preoperatively, our center perform not only ILR, but also distally based delayed lymphatic reconstruction (DLR). In this study, we will compare the incidence of postoperative lymphedema between the ILR treatment group and DLR treatment group during the same period. METHODS: In this retrospective cohort study, we analyzed 38 patients who had undergone mastectomy for node-positive unilateral breast cancer in our institution between November 2020 and October 2021. To compare the effect of preventive LR, we divided the patients into a ILR group (n=16) and a DLR group (n=22). For patients with at least 24 months of follow-up, we analyzed patient demographics and individual characteristics of patients who developed lymphedema. RESULTS: During a mean follow-up of 28 months, one patient (6.3%) was confirmed to have upper extremity lymphedema in the ILR group, whereas 5 out of 22 patients (22.7%) were diagnosed in the DLR group. In terms of individual LE patients, 5 out of 6 (83.3%) were treated with radiation, and were diagnosed between 7 and 21 months after lymphatic reconstruction (median = 18 month) CONCLUSIONS: Our results suggested that ILR in the axillary region seems to have a better prophylactic effect than distally-based DLR. There is a need for larger studies with longer follow-up to confirm the findings obtained in our study. REFERENCES: 1. Chung JH, Kwon SH, Jung SP, Park SH, Yoon ES. Assessing the preventive effect of immediate lymphatic reconstruction on the upper extremity lymphedema. Gland Surg. 2023 Mar 31;12(3):334-343. doi: 10.21037/gs-22-554. 2. Chen WF, Knackstedt R. Delayed Distally Based Prophylactic Lymphaticovenular Anastomosis: Improved Functionality, Feasibility, and Oncologic Safety? J Reconstr Microsurg. 2020 Nov;36(9):e1-e2. doi: 10.1055/s-0040-1716743.